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Unipolar Depression and the Progression of Coronary Artery Disease: Toward an Integrative Model.
MedLine Citation:
PMID:  21646821     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background: Despite extensive research on the relationship between depression and coronary artery disease (CAD) after an acute coronary syndrome (ACS), causal interpretations are still difficult. This uncertainty has led to much confusion regarding screening and treatment for depression in CAD patients. Method: A critical and conceptual analysis of the pertinent literature, which elaborates the implications of the heterogeneity in symptom pattern, etiology, and course of depression in CAD patients. Results: We propose an integrative dynamic model of the depression-CAD relationship. The model rests on three core hypotheses: (1) Depression in CAD patients consists of mixtures of two types of depression, denoted as 'cognitive/affective' and 'somatic' depression, each having a somewhat characteristic symptom expression and etiology. (2) Effects of depression on CAD depend on the type and duration of depression. The dynamic aspect of the model indicates that post-ACS depression shifts, when it persists, from a marker of the severity (somatic type) and meaning (cognitive/affective type) of the ACS to a largely indirect causal factor in the progression of CAD. (3) The most plausible pathways mediating the effects of persistent/recurrent depression, irrespective of type, on cardiac prognosis are behavioral and act by making depressed CAD patients more susceptible to other CAD risks. The model offers testable predictions and explanations for a variety of apparently unrelated or inconsistent findings. Conclusion: The proposed model may have potential for integrating findings regarding the depression-CAD relationship, contributing to the clarification of discords on screening and treatment of depression, and guiding future research.
Authors:
Johan Ormel; Peter de Jonge
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-6-01
Journal Detail:
Title:  Psychotherapy and psychosomatics     Volume:  80     ISSN:  1423-0348     ISO Abbreviation:  -     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-6-7     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0024046     Medline TA:  Psychother Psychosom     Country:  -    
Other Details:
Languages:  ENG     Pagination:  264-274     Citation Subset:  -    
Copyright Information:
Copyright © 2011 S. Karger AG, Basel.
Affiliation:
Interdisciplinary Center for Psychiatric Epidemiology (ICPE), Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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